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Positive COVID-19 Test Form

  • Directions:

    Complete the form below if you have tested positive for COVID-19. Refer to the latest CDC guidance updated March 1 regarding isolation, testing and masking. You can go back to your normal activities when, for at least 24 hours, your symptoms are getting better overall and you have not had a fever (and are not using fever-reducing medication)

    You should only complete this form if you test positive.

  • Name Name *
  • Best phone number to be contacted at Best phone number to be contacted at * - -
  • Supervisor Name Supervisor Name *
  • Supervisor Notification *
    Supervisor Notification
  • Enter Day 0 of your isolation (day of first onset of symptoms). Refer to CDC isolation guidance. You are eligible to return when your symptoms are getting better and you have been fever-free for 24 hours. Enter Day 0 of your isolation (day of first onset of symptoms). Refer to CDC isolation guidance. You are eligible to return when your symptoms are getting better and you have been fever-free for 24 hours. / /
    Pick a date.
  • Isolation plans *
    Isolation plans

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Brockport, NY 14420